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U.S. Postal Service' <br /> CERTIFIED MAIL° RECEIPT <br /> r Domestic Mail Only <br /> ►� For delivery information,visit our website at www.usps.com®. <br />--Rl Certified Mail Fee RECEIVED <br />✓ Extra Services&Fees(check box,add fee as REC E I V E. <br /> ❑Return Receipt(hardcopy) $ /�t <br /> M El Return Receipt(electronic) $ AUu V471 <br /> ❑Certified Malt Restricted Detivery $ AUG I ?Ott I G 5 ?O <br /> M ❑Adutt Signature Required $ 1 -L`t_ <br /> ❑Adult Signature Restricted Delivery$ <br /> Postage •ord u l ivision of Reclamation, <br /> $ [b- Mining and Safety <br /> 1J Total Postage andes <br /> ti $ <br />-q Sent To :: 1 <br /> Street and -: r `�oz:N6. <br /> ti <br /> City,34ate,21 g, r151Yv� r <br /> PS Form 3800 A.ril 2015 PSN7530-02-000-9047 See Reverse for Instructions <br />